Methotrexate

Few people want to take multiple medications for the same condition, but sometimes that’s the best course of action to manage symptoms and prevent disease progression. That tends to be the case for patients with moderate-to-severe rheumatoid arthritis (RA), who often use methotrexate (which is common first-line treatment for RA) as well as a TNF inhibitor or other biologic drug such as a JAK inhibitor.

But what happens when those same patients improve on the drug combination?

Some RA patients who take methotrexate plus another drug have been opting to stop the methotrexate once they reach remission or low disease activity, though whether that’s a safe or risky move has been unclear. Now a new study, presented at the European Congress of Rheumatology (EULAR 2019) in Madrid, suggests that withdrawing from methotrexate while continuing with another agent for RA is likely safe.

The study, led by Stanley Cohen, MD, of the University of Texas Southwestern Medical Center in Dallas, was a randomized trial of 530 RA patients who had achieved low disease activity thanks to using both methotrexate as well as tofacitinib (Xeljanz). Half were randomly assigned to continue with the combination of these two drugs, while the other half was assigned to take Xeljanz plus a placebo. After 24 weeks, disease activity scores in both groups remained almost identical.

The news isn’t all good, as 40 percent of participants in either group experienced an adverse event. But these findings do suggest that some patients who reach remission might be able to safely stop methotrexate without leaving themselves more vulnerable to an arthritis flare. Still, there may be other reasons to stay the course, so more data is needed before making any changes to treatment guidelines, John Isaacs, MBBS, PhD, chair of the EULAR Abstract Selection Committee, told MedPage Today.

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